REVIEW QUESTION

How effective are interventions for relieving heartburn in pregnancy?

TYPE OF REVIEW

This is a Cochrane systematic review of nine randomized controlled trials comparing various interventions in relieving heartburn in pregnancy.

RELEVANCE FOR NURSING

Heartburn is a common gastrointestinal symptom that may occur in any trimester of pregnancy. In order to safely advise and help pregnant women who suffer from heartburn, nurses need to identify interventions that are effective in its relief. Interventions used in the treatment of heartburn during pregnancy include advice on diet, lifestyle modifications, and medications. Since heartburn has an impact on a pregnant woman's quality of life, it is important to consider her satisfaction with treatment and to evaluate the effect of specific interventions on her well-being.

CHARACTERISTICS OF THE EVIDENCE

This review contained nine randomized controlled trials, of which only four trials contributed relevant data. A total of 358 pregnant women who reported heartburn were included in the analysis. Interventions for the treatment of heartburn in pregnancy that were included in the four trials were advice on diet, lifestyle modifications, medications, and complementary therapies. Three main comparisons were evaluated: medication versus placebo or no treatment; acupuncture versus no treatment; and medication versus advice on dietary and lifestyle choices. The primary outcome was the relief of heartburn (complete or partial relief measured by frequency of heartburn).

Medication vs. placebo or no treatment. One trial (n = 100), conducted more than 50 years ago, compared the effect of 0.5 mg intramuscular prostigmine (a treatment rarely used today) versus placebo. Another trial (n = 156) compared the effect of magnesium and aluminium hydroxide plus simethicone liquid or tablet with placebo. Women who received drug treatment reported complete heartburn relief more often than women receiving no treatment or placebo.

Medication vs. advice on dietary and lifestyle choices. One trial (n = 65) compared 1 g sucralfate to advice on dietary and lifestyle choices. More women in the sucralfate group experienced complete relief of heartburn compared with those who received advice on diet and lifestyle choices.

Acupuncture vs. no treatment. One trial (n = 36) included women ages 15 to 39 years, at 15 to 30 weeks of pregnancy, who received acupuncture or no treatment. This study did not report data related to the relief of heartburn. With regard to quality of life, women who had acupuncture reported an improved ability to sleep and eat.

No differences in adverse effects were found between the treatment groups.

BEST PRACTICE RECOMMENDATIONS

There is insufficient evidence to show that heartburn in pregnancy can be completely relieved by any medication and insufficient data to assess acupuncture versus no treatment. Because of the low level of evidence from the four randomized controlled trials, recommendations cannot be made as to which is the best treatment for heartburn in pregnancy.

RESEARCH RECOMMENDATIONS

Well-designed randomized controlled trials are needed to determine the effectiveness of pharmacologic and nonpharmacologic interventions in the relief of heartburn in pregnancy. It would be useful to evaluate medications such as antacids, sucralfate, histamine 2 receptor antagonists, promotility drugs, and proton pump inhibitors. Future research should also evaluate the woman's satisfaction with treatment as well as its effect on her quality of life.

REFERENCE